<form id="frmModal" name="frmModal" action="<?php echo site_url(array('psdm','kota','ajax','update')) ?>" method="post">
<h3 class="dialog_title"><span>Edit Kota</span></h3>
<div class="dialog_content">
<div style="border-bottom: 1px solid #CCC; padding: 10px 0" >
<table width="100%" border="0" cellpadding="5" cellspacing="0">
	<tr>
		<td align="right" width="35%">Kode Kota:</td>
		<td>
			<input type="text" maxlength="4" class="validate['required']" disabled="disabled" value="<?php echo $kota_id?>">
			<input type="hidden" name="inp[0]" maxlength="5" value="<?php echo $kota_id?>">
		</td>
	</tr>
	<tr>
		<td align="right">Nama Kota:</td>
		<td><input type="text" name="inp[1]" maxlength="20" class="validate['required']" value="<?php echo $kota_nama?>"></td>
	</tr>
	<tr>
		<td align="right">Propinsi:</td>
		<td>
			<input type="text" name="inp[4][fake]" disabled="disabled" value="<?php echo $propinsi_nama?>" />
			<!-- <select name="inp[4]">
			<?php if ($prop_data->num_rows() > 0):?>
			<?php foreach($prop_data->result_array() as $row):?>
				<option value="<?php echo $row['propinsi_id']?>" <?php if ($row['propinsi_id']==$propinsi_id):?>selected="selected"<?php endif?> >
				<?php echo $row['propinsi_nama']?>
				</option>
			<?php endforeach?>
			<?php endif?>
			</select> -->
		</td>
	</tr>
	<tr>
		<td align="right">Kode Pos:</td>
		<td><input type="text" name="inp[2]" maxlength="20" class="validate['required','number']" value="<?php echo $kota_kode_pos?>"></td>
	</tr>
	<tr>
		<td align="right">Kode Area Telepon:</td>
		<td><input type="text" name="inp[3]" maxlength="5" class="validate['required','number']" value="<?php echo $kota_kode_area_telepon?>"></td>
	</tr>
</table>
</div>
<div class="dialog_buttons" style="padding: 12px 10px">
	<input class="button" type="submit" value="Save"  />
	<input class="button" type="button" value="Cancel" onclick="FBModal_hide()" />
</div>
</div>
</form>